new comer to this cite

[maritza2]

Cycler Wrote:Maritza,
You leave important details about your treatment to date out of your post that may alter my opinion but if one is to take the spine literature at face value it really is unlikely that more "therapy" is all that separates you from recovery for such a remote injury. Absent a specific treatment plan with a reasonable chance of recovery, such as surgery this far out, I think most Drs would find you at MMI and it really would only take about 10 minutes to sort that out as the IME's job is not to figure out what is wrong but only to comment on the patient as he finds them in relation to the treatment and plan to date. It's not a medical consult but an insurance evaluation. Just my opinion....

I have been trying to answer your e-mail since I read it and had defeculty do so. I had to re-open another account.
I was a little confused with your respond. You sound like the significant other of the IME doctor I saw. I do not agree with you on what the you feel the IME doc is suposed to do. I had symptoms he did not report. These included swelling on my shoulder, some limitations to motion in the same shoulder. He also did not mention the dificulty I had in performing some of the tests he did. I also had swelling in my cafts from pain on my leg, and he did not mention non of this either. However, he notice the sweeling on my left caft, and he questioned me about it, but also did not mentioned it. I had 3 procedures consisting of 2 epidurals at the hospital and 1 infusion to disc 5 with medication to decrease the swelling. All this in a 3 yr period.
I am presently getting every 5 to 6 weeks cortizone shots in my lower back done under an exray machine that shows the area with my problem. My pain management says that these shots are nerve blocking pain medicine. They do not seem to make me better, but they do give me some relief with the pain. I also go to therapy 3 times a week. theire are days that I feel that therapy will not make me anymore better than I am, but if I do not go I feel worse with the pain. Therefore, if these doctors treat me for a condition I trully have, how can the IME doctor say, I am fully recovered in ten minutes or less , when he does not trully report what he see's. I beleive the IME doc reported what the W/C Ins wants him to report in order not to pay for anything, or just simply prolong them paying. I know that there are people out there that fake injuries. I am not one of them.

[Cycler]

" I do not agree with you on what the you feel the IME doc is suposed to do. I had symptoms he did not report. These included swelling on my shoulder, some limitations to motion in the same shoulder. He also did not mention the dificulty I had in performing some of the tests he did. I also had swelling in my cafts from pain on my leg, and he did not mention non of this either. However, he notice the sweeling on my left caft, and he questioned me about it, but also did not mentioned it. "

He should have; that wasn't my point. It is definitely not his job, nor even allowed, barring life threatening findings, to make mention of new diagnoses or conditions unless specifically asked to so. IME's only comment on what is asked of them and if you don't see the questions it's hard to know.

I had 3 procedures consisting of 2 epidurals at the hospital and 1 infusion to disc 5 with medication to decrease the swelling. All this in a 3 yr period.
I am presently getting every 5 to 6 weeks cortizone shots in my lower back done under an exray machine that shows the area with my problem. My pain management says that these shots are nerve blocking pain medicine. They do not seem to make me better, but they do give me some relief with the pain. I also go to therapy 3 times a week. theire are days that I feel that therapy will not make me anymore better than I am, but if I do not go I feel worse with the pain. Therefore, if these doctors treat me for a condition I trully have, how can the IME doctor say, I am fully recovered in ten minutes or less , when he does not trully report what he see's.

It can be pretty straightforward to determine MMI status and the exam itself may add little to that determination. Mostly it's based on the record of treatment to date and any future plan in relation to the length of time of the claim. Most Drs know by now, based on the medical literature, that there is no evidence that all these injections improve outcomes or even have much effect on symptoms.

THere is a great deal going on in the medical literature today about the Myth of Pain Clinics and what a scam they are with everybody and their brother sticking needles in people and prescriptions for Vicodin. THere is no data to say any of this works and quite alot of studies showing it does not. So it really can be straightforward and quick to say someone is at MMI by reviweing the treatment record and MRI's EMG etc. I am not saying you are in particular but you asked...

I have access to a monthly commentary/compilation of all the peer reviewed and research studies in something called The Back Letter where all this is often published.

"I beleive the IME doc reported what the W/C Ins wants him to report in order not to pay for anything, or just simply prolong them paying. I know that there are people out there that fake injuries. I am not one of them."

You are correct, there are many Drs who have put their medical license up for sale to the Insurance companies and they rarely have the credentials or training in the areas they are asked to examine. Not everyone gets better though, despite excellent care, Nor is there any real effective treatment for the majority of chronic mechanical back pain patients. Surgery really only works for those with nerve damage causing motor loss according to the literature. See the SPORT study published last year.

In a nutshell, if your only treatment is injections and they are not improving your function, any Dr. knows they do not work in the majority of patients and so can make the opinion that the injured worker is not going to get any better no matter how many more shots or drugs since the injury is of a certain time frame, and so is likely at MMI.

On the other hand if an IME Dr sees that there is radicular pain, loss of reflex or strength loss that corresponds to the spine problem seen on MRi etc BUT there is no indication from the treating Drs that they are considering getting a surgeons opinion, the norm in most of these injection mills, the IME Drs is STILL correct to say the IW is at MMI given the treatment plan. Only if the requesting party asks for recommendations is the IME Dr. really able to recommend a surgical opinion and pend MMI until that is done.

It makes no real sense but that is the way it works. Comp is not a medical system and doesnt work like one, it's an insurance system. You can only provide a supporting medical opinion for your side and hope for the best.


Good Luck